Healthcare Provider Details

I. General information

NPI: 1326427246
Provider Name (Legal Business Name): KERRI PESCHOCK RN,MS,CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 SMITH AVE. SUITE 210
BALTIMORE MD
21209
US

IV. Provider business mailing address

113 MIZEL LN
JOHNSTOWN PA
15902-1328
US

V. Phone/Fax

Practice location:
  • Phone: 410-735-6665
  • Fax:
Mailing address:
  • Phone: 814-421-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN616564
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN616564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: